Hybrid Inside-Out–Outside-In Meniscal Repair Through a Small Skin Incision

Although the updated generation of all-inside devices for meniscal repair is more convenient to deploy and can provide comparable clinical outcomes with those of the inside-out procedure, the latter is still a very useful technique, giving many advantages over the former. The critical drawback of the conventional inside-out technique is the need for preparation of the accessory incision to prevent the risk of soft-tissue entrapment and neurovascular injury while retrieving the exiting meniscal needles, especially at the posterior corner of the knee. To minimize the space volume of the incision, a small, bluntly dissected track guided by the first exiting meniscal needle is sufficient in our hybrid inside-out–outside-in technique. The guiding cannula for the first meniscal needle passage is a commercial inside-out device, whereas the guiding cannula for retrieval in the subsequent meniscal needle passages is a spinal needle applied in an outside-in manner via the small track. Subsequent meniscal needles can be inserted in an inside-out or outside-in manner according to the design of the suture construct.